It was just like any other day for 19 year-old Mario del Fierro. He had practiced his dance routine — a mix of modern-day hip hop and Eskrima, a Filipino martial art class — to perfection. But during his performance, Fierro did a backhand spin and his knee landed on a pole.

Life hasn’t been the same since, the now 23 year-old says.

“I feel as if I got a shotgun taken to my knee and it’s like there’s a big hole in it. When it doesn’t have that pain, it travels, going to my achilles and the back of my leg. I can still walk on it, but then I’ll have sharp pains for an hour or two. It happens as soon as I wake up.”

Fierro’s parents had insurance that gave him access to a sports doctor, an MRI scan for his knee and medication that dulled the pain. But he got older and worked instead of attending college; his parents’ insurance plan stopped covering him. Fierro moved from job to job and has been unable to secure medical coverage.

“I ended up taking alternate routes,” Fierro says. “I checked stuff up online, looked up simple physical therapy things. It was just me and a lot of Icy-Hot.”

Fierro is among the nearly 46 million Americans without health insurance. The 12 to 20 million undocumented immigrants in the United States are not included.

Like Fierro, many rely on home remedies for their ailments, while others wait until they need to go to the emergency room, where they can’t be denied health care.

But holding out until large procedures become necessary are taxing – in both senses of the word. Rebecca Kavoussi, assistant vice president of government affairs at Community Health Plan, says not only does it cost more money to not seek preventative care, but the ill are often left sicker and weaker.

“Anyone who walks through the doors of a community health center gets help, regardless of their insurance status,” Kavoussi says. “It’s the law.”

Terasita Batayola, chief executive officer of International Community Health Services, says out of more than 17,000 patients the clinics served, at least 20 percent of patients her clinics serve had no insurance.

ICHS was where Kylee (whose name has been changed to preserve her family’s privacy) sought help for her now 31-year-old daughter.

Kylee’s daughter was diagnosed with IgA nephropathy in April 2009, which left 20 percent of her kidneys functioning.

“The doctors said she had to get a kidney transplant or get dialysis,” Kylee said. “Dialysis would weaken her. She’d never be able to go back to work if she had to go in for dialysis two or three times a week. But all the bad stuff happened before we could even start looking for a [kidney] donor for the transplant.”

The bad stuff: Kylee’s daughter was laid off after taking a one-month leave of absence. Her employer extended her insurance coverage for six months, but that has passed. Her husband is a contract worker and has no health insurance.

“She was denied Medicaid,” Kylee says. “They said she was making too much money on unemployment.”

Kylee went to her legislators for help. From Congressman Jim McDermott, she learned about the King County Project Access, which connects low-income families to community and public health clinics. That was where Kylee learned about ICHS.

Kylee’s daughter got to see a nephrologist and receive drug prescriptions. Now in question is a kidney transplant that could save her.

“The doctors aren’t going to test someone because they don’t know who’s going to pay,” Kylee says. “A transplant only lasts for 15 years and I can’t imagine without insurance, how much it’s going to cost.”

Recent passage of the health-care reform bill provides some relief for non-insured Americans such as Fierro and Kylee’s daughter. It requires everyone to have some form of insurance, but the legislation outlines low-cost, accessible plans. For those who have suffered from lack of insurance in the past, this could be hope for relief in upcoming years.

In the mean time, local groups such as the Washington Community Action Network and Community Health Plan are focusing in on local legislation that would keep community health clinics open and available to the public, in addition to keeping immigrant-specific services such as translators out of state budget cuts.

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